Loading...
HomeMy WebLinkAbout0143 SADDLER LANE - Health 143 Saddler Lane West Bamstable A= 151 - 018 0 Commonwealth of Massachusetts 151--D76 Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v/. 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name information is / required for every West Barnstable V MA_ 02668 1-28-20 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. OF Important:When �. filling out forms A. Inspector Information /#- 2s.. on the computer, = 1 A 1 E :gym use only the tab James D.Searso :J key to move your Name of Inspector =� �cursor-do not * *c o ert B. ur Co. INC. %�'i:•°FoT,����. Q.c use the return - --- - -- -- �- •• ��, key. Company Name ylF'S•IN.Sp�G`````��� 363 Whltes Path ���rrrffttauuntl"`� Company Address South Yarmouth MA 02664 _ City/Town State Zip Code 508-477-8877 _ S1623 _ Telephone Number License Number B. Certification certify that; I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails G,tslZd_�� _ 1-28-20 _ pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.V26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name information is West Barnstable MA _02668 _ 1-28-20 _ required for every _ _. _.._ _ _ page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal. Tank D Box and 12 chamber's 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'v 143 Saddler Lane Property Address Ronald Pfeiffer _ Owner Owner's Name information is required for every west Barnstable _ _ _ MA 02668 _ 1-28-20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l6inap.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 l I Commonwealth of Massachusetts l? Title 5 Official Inspection Form F' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments LvL/ 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name information is required for every West Barnstable MA _ _02668 1-28-20 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cost.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form 9 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name information is West Barnstable _ required for every _ MA 02668 1-28-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/Z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will.be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.MOW 8 Title 5 official Inspection Form:Subsurface Sewage Disposal system-Page 5 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �VVY-4 — 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name information is required for every West Barnstable MA 02668 1-28-20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304, The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] tsinsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,• 143 Saddler Lane Property Address - Ronald Pfeiffer Owner Owner's Name information is West Barnstable required for every MA 02668 1-28-20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): - 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 1000 Gal. Tank D Box and 12 chamber's. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2018-60,000Gals 9 ( y g (gp ))' 2019-63,000 Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doo-rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •°'�° 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name information is West Barnstable required for every _ MA 02668 1-28-20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: — Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: — Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: -9-27-18 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: - — gallons How was quantity pumped determined? Reason for pumping: — t5illsp.doc rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page a of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V t; 143 Saddler Lane Property Address Ronald Pfeiffer Owner OwnePSName information is West Barnstable _required for every MA 02668 1-28-20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information; 2009 Permit 2009-010. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 38"feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.); Pipeing is 4" PVC SCH -40. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name information is required for every West Barnstable MA 02668 1-28-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 28"feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑-Yes ❑ No Dimensions: _1000 Gal. Precast H-10 Sludge depth: -- 1" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 8" Distance from top of scum to top of outlet tee or baffle 0" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and inlet cover at 28"below grade. W/outlet at 5"in and outlet tee's. No sign of leakage or over loading. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name information is West Barnstable _required for every _,. _ MA 02668 1-28-20 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain); Dimensions: Scum thickness — Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5inap.doc-rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 f - Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name information is West Barnstable MA required for every 02668 1-28-20 _ _.,.-_ _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: -- Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"xl6"-3' below brade w/cover at 20". Box is clean and solid. No sign of over loading or solid carry over. _ t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form!Subsurface Sewage Disposal System•page 12 of 18 Commonwealth of Massachusetts 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments L,v 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name - '--- information is required for every West Barnstable MA 02668 1-28-20 page.. C4frown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 12 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doe•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r— i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name Information Is West Barnstable MA 02668 1-28-20 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 12 Biodiffusers. Two set's of six each row. Chamber's are clean w/no sign of over loading w/inspection port. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool — - Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name information is required for every West Barnstable MA 02668 1-28-20 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 13. Privy (locate on site plan): Materials of construction: Dimensions -- Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t; • 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name information is every West Barnstable _ required for eve MA 02668 1-28-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t5insp.00c•rev.7/26/2018 Title 5 Official Inspection Form:Subsurrace Sewage Disposal System•Page 16 of 16 NUMBER OF-SE! DESIGN FLOW.! -TOTAL DESIGN` L: AC€ l M2,PIT-ro e E DESIGN FLOW AND.ABANDONED, USE PROPOSEI STRIBUTION BOX' 2 ARC 36HC BIOD►FFUSERS INSTALL-_l i DER TRENCH] .- . .. e SYSTEM_CA OTAL L F. _ (62.4`�(7.8 SFA C • � � � �TOTAIS: GARAGE 03� t s g TOTAL NU TOTAL NU TOTAL LE A TOTAL LE _ NOTE 5) T EFFECTNE'I 1DEPARTMEt "MODIFIED t �r.. _A$=Bl1ILT SWING-TIES; a ADVANCED OD FIE�� _ • � M� I DJ _ DESCRIPTION., A 8 G SEP, ' TIC CO N(1) . -- 23.0' 5' e s - VER d . w _SEPTIC COWR'OUT(2) 28.0' MR TDISTRIBUTION BOX 40: le, INSPECTI N �s 0 PORT(4) ; 38.0' 31.W a r. - E INSPECTIO PO O� A L , ... m - - 4 M a° i r �a _ Commonwealth of Massachusetts (p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 143 Saddler Lane Property Address Ronald Pfeiffer _ Owner information is Owner's Name required for every West Barnstable— _ MA 02668 1-28-20 page. Cityffown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells No Estimated depth to tlgh ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1-8-09 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H. on Design plan 1-8-09 11'.8" no G.W.. Bottom of chamber's at 5'-3" below grade. Bottom of chamber's at 6'-5" above T.H. Depth.. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Ip Title 5 Official Inspection Fo rm o rm Y a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 143 Saddler Lane Property Address Ronald Pfeiffer Owner Owner's Name -- information is MA 02668 1-28-20 West Barnstable required for every ___._ page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form Inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included Orrom Ills M,3F L'5 _No �s•W, t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 18 of 18 V4o10 w �6 N P U � / 3 �'� r o NEW ae""xcStwG .y SumfW,1 GARAGE } / x� e 1 i9 O i. i -7 Joe # 85-309 CEPTIFIED PLOT PLAN PREPARED FOR. LOCATION. L--73 SADDLER LN . BARN . SCALE: 1=40 DATE: 12116/09 REFERENCE: PB 420 PG 97 LEBEL / SOLLOWS I HEREBY CERTIFY THAT THE BUILDINGS SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON: BUILDINGS CONFORM TO SETBACK REQUIREMENTS OF THE TOWN WHEN CONSTRUCTED. �H OF ARNE down cape engineering °JALA � rzs34e o CIVIL ENGINEERS E� TER LAND SURVEYORS ROUTE EA YARMOUTH MA DATE REG. LAN SURVEYOR e TOWN OF ARNSTABLE 10 LOCATION SEWAGE#Q� P� VILLAGE 9 „ �SSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. f./z Cd rx SEPTIC TANK CAPACITY — C LEACHING FACILITY:(type) t'/' (size) 6 w d NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY p-lzoti r ® o r IV e 3 oq. y TOWN OF BARNSTABLE LOCATION / SEWAGE# '1001 VILLAGE iJ 1 a-M S 1-r-b U. ASSESSOR'S MAP&PARCEL /S/ - ?J' INSTALLER'S NAME&PHONE NO. AyA to(J,D y Z f AFC)-Z F SEPTIC TANK CAPACITY 1 SW O `17410 LEACHING FACILITY: (type) Q) au -E�krrP '�wNck(size) 2� � X .30 NO.OF BEDROOMS OWNER f-/zu 1/7 PERMIT DATE: J u t aq COMPLIANCE DATE: 10 -10001 Separation Distance$etween the: r ?� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility (lb faa� i ' feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and L-aching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY CA w,v� -XLI / ,f, eS C.� an+ c�( 3t�.s 3r a3�b i C3 5-2.0 33 Ll()ou • 01 v No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in compP�y PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 9ppf tatlon for -Mispo8AY *pBtrm Const rtlon i3Prmit Application for a Permit to Construct( ) Repair 0() Upgrade( ) Abandon( ) ❑ stem Complete Sy stem y ❑Individual Components Location Address or Lot No. 14"3 S act best 1.4w-@ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel i `5- 0 fly ti -QS S*TK4L Installer's Nam`e�,Address,and Tel.No. Ie a Dn y�S Designer's Name,Address,and Tel.No. �' y .,,�� —t �f 3 C��rtiru.�l2 Type of Building: c Dwelling No.of Bedrooms Lot Size 0, 3 sq.ft. Garbage Grinder( ) Other Type of Building S ljtc ctM. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date I Q -?.o Number of sheets / Revision Date Title t43 ya �dl Size of Septic Tank i Soo c1�t Type of S.A.S.(Z) 1 -1j1.A--5S `�✓Description of of Soil _CCao Nature of Repairs or Alterations(Answer when applicable) e� /.$�9� / ).Li J p rb Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been iss4ed by this Board of ealth. Si d Date Application Approve by Date Application Disapproved by Date for the following reasons Permit No. Date Issued ; - - - - - -------- ------------ -— T Tu�� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Y 2pplication for bispoBal *pstem Construction Permit A lication fora Permit to Construct( ( ) Repair(� Upgrade( ( )y•❑complete System p y El individual Components Location Address or Lot No. I N 3 S n d f e 2 Lam. Owner's Name,Address,and Tel.No. (-1-4 h k/,•7 tj)C'.Sv,L A Assessor's Map/Parcel I T I byw a V, W 5 - Installer's Name,Address,and Tel.No./�, � E'-� Ira i,,,5 Designer's Name,Address,and Tel.No. Type of Building:Dwelling No.of Bedrooms 3 Lot Size _1G, + sq.ft. Garbage Grinder( ) Other Type of Building i k-t le No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date -Q-Z oC Number of sheets f Revision Date Title l L(3 S v-,.J4 . Size of Septic Tank I SCOO C(.&L , Type of S.A.S.(Zl S-CCn Q� c5� T✓s...< - - Y Description of Soil Co p o W,., m Y. Nature of Repairs or Alterations(Answer when applicable) ryl IL /o rb - i3,� }z. Date last inspected: ° Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in t accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Lg ed Date "f�(.-too5 Application Approved -----�"J Date f f h Application Disapproved by Date for the following reasons Permit No. Date Issued ' ------------------------- ------------ ------------------------------------ -- - =- THE COMMONWEALTH OF•MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliarrce THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( by -p I.-)Zw, f 1 C L L at 143 54A C�,t r L,�r,� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Now d�dated /1�/o Installer �,,,,, �,�(o �'2�G. L l< Designer --� i gn S.C, 01 #bedrooms Approved design flow o ,� � / � (j �d The issuance of this pe rt shall of be-construed as a guarantee that the system w' l�fixnJction as designed. ? Date t �� Inspector / / I� _ �/ /� --------------------- -/----------------- ---------------------------------.- - -- ------------ No. _ --s--` -- J ,.�}_-0/ / . Fee Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS NSPOSar Opstem Construction 13ermit Permission is hereby granted to Construct( ) Repair VQ Upgrade( ,) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this p� - Date Ip �� Approve'd'by— Town o>t barnstante Regulatory Services a Thomas F. Geller, Director MAW ��� Public Health Division Thomas McKean, Director 200 Main Street,11ya,nnis,IVMA, 02601 Qf'ficc; 508-962.4644 Fax: 508.7'g0.6304 IM81211CL& DesignIr Ce Date; Designer: --TL�2eeccnt T C Installer: _C� �.w, G. EnFerpc-(se,, Address: 28151 Crcr►b� _ .� Address: _?�. i�ax 7�3 -- C111 -c J�-=�" - was issued a pel-mit to install a ( ) (instr111er septic system at based on a design drawn by dated ,—,_—, I certify that the septic: system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic systern referenced above was installed with ma'or changes greater than 10' lateral, relocation of the SAS or any vertical felooation of any comporien: Of the septic system) but in accordance with State& Local Regulations, Ilan revision o., certified as-built by designer to follow. JOHN L. tallel''s �;riatUi'e)- ---�'• `; JF;. w 'iVll 4�rl0' 8 (Designer's -- -- _ �..........-.. (Af i estgner's anrip Here) E S RE QF—COMPLCL , ARhI L U C T I3 V C CERIMCA ]E BUi C"2 UCEIVED Y US L-0 THANK Y DIV SI N, Q! Wealth/Septic/Designer Call ific:uion horn, T0 'd 2-9£0 2ZZ 809 0NI2133NIDN33r Wd ZZ: Lo 600Z-01-atiW Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name p� information is required for 0'�' N NV QS,I- r � IJ Ma. 02632 12/16/2008 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer, use 1. Inspector: only the tab key to move your Raymond F. Dumas Jr. cursor-do not Name of Inspector use the return key. Dumas Landscape Const. Inc. Company Name 564 old Stage.Road Company Address Centerville Ma. 02632 City/Town State Zip Code 508-778-0249 S1437 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 12/16/2008 Inspector's Sigrhture Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Franklin Desouza Septic inspection.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 . 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M a 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville, Ma. 02632 12/16/2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed Franklin Desouza Septic inspection.doc•03/08 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 2 of 15 I J . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville, Ma. 02632 12/16/2008 every page. CityrFown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: Leach pit failure C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Franklin Desouza Septic inspection.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville, Ma. 02632 12/16/2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑ Any portion of the SAS, cesspool or privy is below high groundwater elevation. ❑ ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Franklin Desouza Septic inspection.doc•03108 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville, Ma. 02632 12/16/2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Franklin Desouza Septic inspection.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville, Ma. 02632 12/16/2008 every page. Cityrrown state Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ❑ ® Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] Franklin Desouza Septic inspection.doc•03/08 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is Centerville Ma. 02632 12/16/2008 required for � every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2008/20000 gal g ( y g (gpd)): 2007/68000 gal Sump pump? ❑ Yes ® No Last date of occupancy: now Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Franklin Desouza Septic inspection.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville, Ma. 02632 12/16/2008 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: 10/20/2002 Barnstable waste treatment facility Was system pumped as part of the inspection? D Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 22 years Were sewage odors detected when arriving at the site? ❑ Yes ® No Franklin Desouza Septic inspection.doc•03/08 Title 5 Official insp ection Form:Subsurface Sewage Disposal System•Page 8 of 15 I - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville, Ma. 02632 12/16/2008 every page. City/Town State Zip Code Date of Inspection D. System Information cont. Y (cont.) Building Sewer(locate on site plan): Depth below grade: 6 ft feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 6 ft. feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: approx 6x8x5 Sludge depth: not measured Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Franldin Desouza Septic inspection.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 I I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville, Ma. 02632 12/16/2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): recommend every 2-3 years for septic tank Grease Trap(locate on site plan): Depth below grade: de: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal El fiberglass ❑ polyethylene ❑ other(explain): Franklin Desouza Septic inspection.doc•0310B Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts w v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owners Name information is required for Centerville Ma. 02632 12/16/2008 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cunt.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert d box deep under landscaped banking so pit was inspected and found to be in failure Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Franklin Desouza Septic inspection.doc•03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville Ma. 02632 12/16/2008 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type. ® leaching pits number: 1 600 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 600 gallon pit in hydraulic failure Fraddin Desouza Septic inspection.doc•03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville, Ma. 02632 12/16/2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Franklin Desouza Septic inspection.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments SV.�W 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville, Ma. 02632 12/16/2008 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. - 0 �q Franklin Desouza Septic inspection.doc•03/08 Was:Offd8l>' EontK SvI3stNrace Sewage Disposal System-Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 143 Saddler Lane Property Address Franklin Desouza/Or Owner On Record Owner Owner's Name information is required for Centerville Ma. 02632 12/16/2008 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 38 ftfeet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: design plan on record ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: accessed water contour map You must describe how you established the high ground water elevation: see plan attached last page Franklin Desouza Septic inspection.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 I I r 20,MINI. TOP OF 1 I FOUNo �' SEPTIC TANK'<- 5�rn15T. 00Xr4--L,4 LEACHIt�IG �ACIL1?Y — 10 GAL. r� (q 411T' 0 40 1W �� r SECTION- SEWAGE { "EST HOLE LOGS F''S070 DESIGN FOR 3 � � QD p6p0 TEST 8Y: �� 1�rPF PERC.RAT E <Z MIN./!N. _r}�.. C� FLOW RITE i !�GAL./DAY1 > ' DATE : 1 �JX 1: l [ao,�, • 5EP7/G Is� -Req,o. SEPTIC TANK.; • LEACHING EA_C L1 SIDE WALLLAW �'� 1' 1 - rOTAL Z04,Z 5F. :3 ,'1 G " 4 � U5E_-1--LEACHIN ' - �`'G NOTES 1. DATUM(M5L)t TAKEN PROM NI47 QUADRANGLE MAP 2. MUNICIPAL 14ATER I4 AVAILABLE 3. DE51614 LOAVING POR ALL PRECAST UWlT5%AASNa�'�(�-9 rl ' q. p/PE JO/N75 S+{ALt BE MADE klATER TIGHT, :5. CONSTRUCTION DETAILS TO BE/NAGGORDANCE hIITH I�IO C��C•V COh1M.OF MASS. SrArE ENv/RONMENTAL CODE T/TI.E% 6. rH15 PLAN FOR PROPOSED WORK ONLY AND SHOULD MOf 8E USED Fog PROPERTY° LIJ. STAKING. XtN Or 1N 0 7 �jctfec)LA(_6 4-1-7 o�� tJ-3 � ARNE k. ARNE G� o OJALA m H. "� I clvll h 03ALA Mo. ao # �� docjn cape enq/nee�or�q CIVIL ENGINEERS f 6t�� � � � NA gURV6YOR5 I� 3 PAT ARNE H.OJAI--A,P.E. R.L.S. q2(o Main st.Yarmouth,Mc board of health MA J013 NO. APPROVED , Town of Barnstable P# 9 ��l Department of Regulatory Services SA AB , : Public Health Division,� Date t a l b �As63s� 200 Main Street,Hyannis MA 02601 rFD MA't� Date Scheduled I Time 1 r/ '=z Fee Pd. ®� ' Soil Suitability Assessment for Sewage Disposal Performed By: (WIDeA Qf(Y1QU'1 WL II cs Witnessed Btt LOCATION& GENERAL INFORMATION Location Address 1 41 S,. 1 le4 Lop k Owner's Name F,,,,,t'tc�l w �2Sn�zr0. u�e s II�5 4i Address l N 3 S `�✓ LA- 0-Assessor's Map/Parcel: `�®7 Engineer's Name 6.¢�� (f}l, SIC C"(►c�J2�►'F'�S NEW CONSTRUCTION REPAIR _ Telephone# �0�� �.� 508-273-0377 Land Use Slopes(go) 2 0- 30�a Surface Stones Distances from: Open Water Body. — ft Possible Wet Area ft Drinking Water Well _ ft Drainage Way ft Property Line >/d ft Other '" ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands f'n proximity to holes) I Parent material(geologic) 00�wcs�t Depth to Bedrock 1 Zf O Depth to Groundwater. Standing Water in Hole: `7 1'YQ Weeping from Pit Face i-Y© Estimated Seasonal High Groundwater '> 1 1V0 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Dlrec-t- t)IowUaktovI Depth Observed standing in obs.hole: '7 1 qt) in. Depth to soil mottles: 010 In. Depth to weeping from side of obs.hole: '7)q d in, Groundwater Adjustment — fr. Index Well# - Reading Date: Index Well level Adj,factor., ,— Adj.Oroundwater Level PERCOLATION TEST Date /-8-4 7-4 7 Thne Lo`S b RM Observation Hole# "- Time at 9" /`0 4-17- u Depth of Perc y 2-(00 Time at 6" 11—1d A h Start Pre-soak Time @ I o Y0 A 1`1 Time(9"-611) (N S End Pre-soak /0:5 8 A H Rate Min./Inch b Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) AJ ° Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,% ravel DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) o- H Lj z y2-90 L S pyt o-I ya C, S 2,.3 i V6 Sc,vn�. c�t41oIeS DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Consistency, I Flood Insurance Rate Man: Above 500 year flood boundary No— Yes `. ^ Within 500 year boundary No—Z Yes Within 100 year flood boundary No z Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? `t�s If not,what is the depth of naturally occurring pervious material? Certification I certify that on jo"27"19 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise nd experience descri0ed in 310 CMR 15.017. Signature / Date Q:\.SEPTIC\PERCFORM.DOC COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION '�N SVev i TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: A13 e. Owner's Name: Owner's Address: d 6 eo Date of Inspection:' Name of Inspector: (please print) ��,r/�� 1� Company Name: Mailing Address: t5-6 V Ot D 37W-r,4tV 11001114 Telephone Number: a--7'7 g— W CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP _ approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: . - //Passes _ Conditionally Passes Needs Further Evaluation by the Local Approving Authority' Inspector's Signature: / t Date: °-l 5`—© The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health oP DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 i Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: / Y 3 W > Owner: Date of Ins tion: 0 'R—i s'—a U Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: . B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If`not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 I 4 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: lq3 -► Owner: Date of Insp ction: U T T/.S—0 t, C. Further Evaluation is Required by the Board of Health: V Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15303(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: �(2 _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy of the analysis must be attached to this form. 3. Other: Title 5 Insnection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No ✓Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _✓ Static-liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓Liquid depth in cesspool is less than 6"below invert or available volume is less than%Z day flow _✓Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped ✓Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. AZ y portion of a cesspool or privy is within a Zone 1 of a public well. ./ Any portion of a cesspool or privy is within 50 feet of a private water supply well. any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be.attached to this form.] r�(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of ollowing: (The following criteria app to large systems inn addition to the criteria above) yes no the system is within 4 feet of a surface drinking water supply the system is within 200 e of a tributary to a surface drinking water supply the system is locat m a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a publi water supply well If you have answered"y s"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above a large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Title.5 Tnmen inn Fnrm A/15/2flflf) 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1 Owner: Date of I pection: V $/S—u0 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health ere any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? t,- ave large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) c� Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] TitlF+S TnenPrtinn Fnrm�/15/�(1On 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 1 Property Address: 1413 ya& W. Owner: Date of Ins eetion: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): %S Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 030 Number of current residents: -& Does residence have a garbage grinder(yes or no): /V© Is laundry on a separate sewage system(yes or no): ADD [if yes separate inspection required] Laundry system inspected(yes or no):�D Seasonal use:(yes or no):Lt/t2 Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): HO Last date of occupancy: NJp� COMIIIERCIAL/INDUSTRIAL Type of establishment- Design flow(based on 0 CMR 15 '0 etc.): and Basis of design flow(sea erso /sgft, Grease trap present(yes or )-_ Industrial waste holding resent(yes or no):_ Non-sanitary waste disc ged the Title 5 system(yes or no): Water meter readings, ' availabl : Last date of occup y/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 10 12 8 ) C.2— Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE,(W SYSTEM peptic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool —Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: eta 02c, u4 Were sewage odors detected when arriving at the site(yes or no):9Q 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1 Ll3 ec _t4) Owner: Date of Ins ection: BUILDING SEWER(locate on site plan) Depth below grade:�( _ Materials of construction:_cast iron _ 0 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) r Depth below grade:(— Material of construction: oncrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: ,tee Scum thickness: vmtp Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: b -z., l � Comments(on pumping recommendations, ' et and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,a deuce of leakage,etc.): , . y R- GREASE TRAP:_(locate on site plan) Depth below grade: Material of construc' n: coWete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top scum top of outlet tee or baffle: Distance from b om of sc to bottom of outlet tee or baffle: Date of last p mg: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C (�SYSTEM INFORMATION(continued), 1 Property Address: u Z �-i�.r�&_.-—J(., /vwc� Owner: 224AL ,�. Date of InspeMon: tom— tip TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): e. Dimensions: / + Capacity: allons Design Flow: allons/day Alarm present(yes or Alarm level: Al in working order(yes or no): Date of last pump' g: Comments(con of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): 7� PUMP CHAMBER: (locate on site plan) Pumps in working order so o): Alarms in working order(y or no): Comments(note condi ' of ump chamber,condition of pumps and appurtenances,etc.): R-All;i)nnn 8 Page 9 of l l ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: )q- Ul ,3 vw-, , Owner: Date of Ins ction: — [S—0(0 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type eachin pits,number: g leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration:, Depth—top f liquid to . et invert: Depth of soli s lay Depth of scum er: Dimensions o ce ool: Materials cons tru 'on: Indicatio of ground ater inflow(yes or no): Comm en note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Title 5 Tnmectinn Fnrm 6115/700f1 9 Page.10 of 11 OFFICIAL INSPECTION FORM NUT FOR ©LUNTARY:ASSF.SSMENTS SUBSURFACE SEWAGE➢MOS, L SYS VI IriSPEC' ` ON FORM PART C ', SI'` INFo 0'. (contznuec j Property Address:. 1.Y3 ��� Owner __ Date of Ins one , SKETCH O `S �D S = . lb Title-5 TnenFrfinn.Tinr... Tt cr�niin 1(1 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: (^� ' I >s. ,/;Xa Owner: Date of In ection: —1S''6(v SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water??feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole witlLin 150 feet of SAS) Checked with local Board of Health-explain: way, Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: c Title 5 Tnmectinn Form 6/15/7.060 11 f Z31 { 20'MIN. FouNo. IO'ruN. SEPTIC TANK- 5 rD15T: E50X.4 Z4 > LEACHING FACILI?Y ZS2' 1:141tr.6Rovuocove2- --------� I S U 15� 1000 I�3 GAL. �✓�""' �' , I • Y &I SECTION- 5EGJA6E TEST HOLE. LOGS 2-5070 DE5ICN FOR 3J TEST 8Y � � P� PEFZC.RATE 4-2 MIN./114. FLOW RATE }i06AL.10AY18j NI TNE5.5: I • (21E�l � •� 5EPTIC TANK —2 —R69'0• SEPTIC TANK.: I � �L. LEACHING FAClL I T Y . !r 4 Lap ^A�� -- SIDFWgLL aorTOM — TOTAL Y Zip Z 5F. a — U5E_L_L EACN41!� I I01 �r ��Le 1 - k 4 - hAND - - G - - I�� — NOTES 1. 0ATU1y(MSL){ TAKEN FROM }{4-A4,IN(4j QUADRANGLE MAP 2. MUNICIPAL WATER 1 Lj AVAILA6LE S. DE51GN LOADING FOR ALL PRECAST UNITS:AAS140-'10-4, 4. PIPE JOIN75 5NALL SE MADE WATER TIGHT. 5. CONSTRUCTION bETAILS TO BE I. ACCORDANCE NITH COIJ".OF MASS. 5rATE ENVIRONMENTAL CODE T/Tt.E M: 6. TH15 PLAN FOR PROPOSED ldORK ONLY AND SHOULD NOT _ SE USED FOR PROPERTY: 04. STAKING. OF 7 � r -� � SU ✓�-'� `�``I �f'" s�'e: x�)- ARNE H. ARNE OJALA CIVIL �, v O,1ALA No. 30792 q f263+18 (Yown cape ehglnee q IsrEa ��� A� E9"/ CIVIL ENGIhIEERS LANP SURVEYORS I '= PAT ARNE H.OJALA,PE.,R.L.S. q2� main St.Yarmo�th,Ma board of health J08.N0. APPROVED: DATE.: Id.F$- ,MA TOWN OF BARNSTABLE LOCATION SEWAGE # r-VILLAG ASGESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. \t �A� M SEPTIC TANK CAPACITY \O O C LEACHING FACILITY:(type) (size) 6 O D NO. OF BEDROOMS PRIVATE WELL OR CUBLIC WATE BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: j��n VARIANCE GRANTED: Yes �� No Lo� �'-� W a � 'b �a ' G�� No.....»IL L�-J l �K�� a�= Fxs. ..........:........... SEA THE COMMONWEALTH F MASSALTHTsN E rRD. .OE F. . ......... ... .....---.P I i -° $ Appliration for Moposal Workri Tomitrurtion Permit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ........................�0. ..........:!.:5......... .—L"'ca...... .... .... .............. »............»'.�j + 7►is- ion-A 4a!k .V.. __..... � r-Lot.No. ......................»..........._.. ,r r!.l!�.1. Cf W .� O ner ddre a .......................��li� ... �/+���I�......-------....--- ............ - ,r�'1.1 ..................................... taller Address J0.9.. feet Type of Building Size Lotq. ..� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (,,,W Other—Type e of Building No. of persons............................ Showers — 04 YP g ...--•--•.............•----• P ( ) Cafeteria ( ) a' Other fixtures a (-W- ........................................................... WW Design Flow........... .`..0.-•-•-_..... gallons per �.�r c YTotal da . ew__..._.... . tow. Se tic Tank—Li uid ca acitY gallons Length.. ..Q... Width:. Diameter_______________ Depth �. x Disposal Trench—No..................... Width.................... Total Length ......Total leaching area.__�..�._.....• .sq. ft. 3 Seepage Pit No.................... Diameter.........10_. Depth below inlet...... Total leaching areal�t E.�-sq. ft. Other Distribution bo ) Dosing tank ( ) ' 1� . 0-4 Percolation Test Result Performed by...... ( � .ram...... Date._... ..... r rt Test Pit No. 1....� minutes per inch Depth of Test Pit...l_(p-c._... Depth to ground water._. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ (� W. ........... ....... f,� O Description of Soil...... ' W �--.............�----- ••--� �yr�� .... ....._..... '7CN!.. ............... O --_.�, � . W ----------------•-•---...--•-••---••--------------•------------------------...-•----•-----------------•- = ..-----.................._.. U Nature of Repairs or Alterations—Answer when applicable................................................. . ` -••-----•......................•------•-•-•-•-----•--....._......._._._......_...----....--•---•-----.._..........----------...-----...----•--.....---...--••---........._..-__......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LITLZ 5 of the State Sanitar ode—The ndersigned further agrees not to place the system in operation until a Cert• to of Compliance has e i u ed by and of health. !o // Signed..... . .. .: ... . . ................................................ ...... .�� . ..(�2. q e Application pproved y........ .. ...... .. . .......... -- .. .... ...__..::::: (.-_ . ...... ....G............... Date Application Disapproved for the following a ons:.............: k. .__. .........................................................................•---•--.......-•-----....._........._____--_... .......:.._....-•--•--•--.....--•-----...........__....._.....__----.........» Date Permit No......................................................... Rued... ...... _........... ..... ............ '` Date No THE COMMONWEALTH OF FHEALTH s BOARD _ I OF..................f!,/ ...................................... r 5 I -c5 g Appliration for Disposal Works Tonstrurtion f rrmit Application is hereby made for a Permit to Construct ( )y or Repair ( ) an Individual Sewage Disposal System at: ................_......_LOT .. �..r D t, `12 •........... ............................................................. , ....�p �'...........A... F�n-�.......... at •Addres.. Lot No. / . -Zvnex .» .. ..ust aller eaat ............. .........TYPe of Building Size Lot...1... p :S. Sq. feet aU DwellingNo. of Bedrooms................. .....Ex Expansion Attic — ----••-•--•-••••-••-•• p ( ) Garbage Grinder (/�`/e) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ........:..........................:..Q! _. ...... ...................... • - W Design Flow.......... 'V"Z'�.....................gallons per pe sr o per day. Total daily-flow...........:...--•==-_--...............gallons. G4 Septic Tank—Liquid capacity�!�X.gallons Length.�:�.. Width... �'.. Diameter:............... Depth 1 o W t x Disposal Trench—3 No. .................... Width.................... Total Length...........:!...... Total leaching area.. ........... .sq. ft. I Seepage Pit No........... Diameter.........1.:0 . .. Depth below inlet......r`�....... Total leaching area- � ....�sq. ft. ........ Z Other Distribution box,(U Dosing tank ( ) c f Percolation Test Results Performed by...... ..- (�'�-• — _ .... Date.....!A.1 (0 J:.... Test Pit No. I...��� inutes per inch Depth of Test Pit_. . � ..._ Depth to ground water... (...-._a.. 44 Test Pit No. 2....... minutes per inch Depth of Test Pit.................... Depth to ground water........................ .. : ..."ODescription of Soil......: Y � .A V� V-0). ✓� a ' . ....:..... -. -.---W .........................•-----.........-----.............._......................_....._............_.......................:..........................................,�. U Nature of Repairs or Alterations—Answer when applicable.................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed In ividual Sewage Disposal System in accordance with the provisions of:ITLZ 5 of the State Sanitary'dode— The I ersigned further agrees not to place the system in " operation until a Cert to of Compliance has b i ue�by hoard of health. Signed. Application pproved y........!-.._ !1 ._...... l.-a aM t ,...-•--•-....-•••-•-•---•-•-- ySe :—- p Applicationreasons: t ' !Date PP Disapproved for the following reasons:.............:..................•-----••----.......---...--•--...---•---..............._.......--•--........... ----------------••----.............--•---••-•-•------•-••••....-•-.....-•----•--•-------......................................•••.........•-•••--•-•--..................-•----•----....---•-......------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHU ETTS BOARD OF HEALT i .......... � .. .............OF.......1.,....; ...) J .... '..1 ......�................ Tertif uttte of TontpItttnrr THIS W_To CERTIFY, That the��j�vi�u�l-Se��;I � is�os/al �s�teyn constructed ("oraired ( ) by........... .......... 7 ...... :.. �:.----•--'-•-/--- - i i �--� J/ -. ( 7 Installerlt '�..................................: at...............r>._ .......................z 1- . .... .........._..---- ...................................................1 ..................................... has been installed in accordance with the provisions of TITIZ 5 of Th_e State Sanitary Code as described in the application for Disposal Works Construction Permit No........ 6-.....?1. ....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. ... ....._................ Inspector.......................................................... .. k. r•aa wrs recta�orfirenawnorcrw era". ac.-r..nc.wuwas«c.:e:er_ k;e,=eseresar•�'q.easer�r.:e ems. ....ce zr wse.oe•t�a�..� ,.;,>mr-vwww n..ertv rcwr.•+ k)O�C THE COMMONWEALTH OF M'ASSACHUSETTS u BOARDS F HEALTH Ca (1 1 ..............OF.......:. ..t. J.... �. 1�fir................ No.............- ........ FzE........................ Disposal G E. o sY' trurtion Permit I - s ere by go ihranted.. .......Permissi . ............ .--•-•-•---...•-••---••...••••-•......................................_._.... to Construct o ' R it anaInd-y-id al e�va e Dis�osal stem /� s at No....:..:........... .�_f:. � �.: ... t... .�.... J................................ Y •`E` 9 Street C� as shown on the appl tion for Disposal Works Construction Permit/No.................... D7ated....... �/.__.................�..... b Board of Health DATE............. I.. ...S-•-..........................................._ 362-4541 926 main street y'armouth mass. 02675 dOWa Cape eng�neeiing civil engineers&land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys site planning sewage system designs October 23, 1986 inspections Board of Health Town of Barnstable permits South Street Hyannis, MA Gentlemen: On October 20, 1986 Down Cape Engineering inspected the septic system on Lot 73 Sadler Lane, Centerville. The system as installed conforms with Mass. Environmental Code Title V and the Barnstable Health Regulations and Down Cape Engineering site plan #85-309-73 dated 8/7/86. See attached "as-built" sketch plan. Very truly .yours, Arne H. Ojal ,.P.E., R.L.S. Inspected by Carol Young AHO/amp • i Lo -7Z �v v /n ,A �6 P (1 / c_ hn•n. �\cPhilit. Jyp a / J L_c.T -7 4 j, JOB # 85-309 CEPTIFIED PLOT PLAN PREPARED FOR.- LOCATION: L-73 SADDLER LN . BARN . SCALE: 1=40 DATE. 9/17/86 REFERENCE: PB 420 PG 97 LEBEL / SOLLOWS I HEREBY CERTIFY THAT THE BUILDINGS SHOWN ON THIS PLAN IS LOCATED ON THE. GROUND AS SHOWN HEREON. BUILDINGS CONFORM TO SETBACK REQUIREMENTS Of OF THE TOWN WHEN CONSTRUCTED. ARNE g H. down cape engineering °26U o CIVIL ENGINEERS �f�A it LAND SURVEYORS /��9' C ROUTE 6A YARMOUTH MA DATE REG AN6JSUPVEYOR Am TOWN OF 5.&P; I61-A5-a'55ES50R5 MAP' LOT lo, 2o'MIN. ;ij ZONING : ¢l� 170 of I runs. FOUND. p r i ' 5ET$ACK5: FRoNT:7.5SroES=75RE/�+R= �.5 SEPTIC TANKF 5 —DIST, 150Xr4 Z4 LEACHING FACIL17Y i ` ZQ 6RO(lNDCOYEfZ -------_� 7-7 1000 3.7 �q5 9 z• - ii \ / .,.; )C�a0 1� D SECTION- SEGJAGE C1-, 33,CDt— Q r 4 TEST HOLE LOGS P'SD70 DESIGN FOR N TEST 5Y: P F PERC.RATE GZ IN. (N. `J DATE . 'i � FLOW P '.)GAL./DAY1�WlTNE5.5 -OLT.ok [�, � 5EPT/C TANK -RE¢'o. SEPTIC rANK l �=� / 20 r LEAC I G FACILITY _ ! (l��( / `• :�� � y �' ^pest �'� f (��� � Q f� — W SIQE WALL — TOTAL ZCG4 Z 5F. =3°(Z,IG/o v f j .�� y' s' r 143.0 — USE _L EACHIN ► f NOTES _ I. DATUM(MGL)t TAKEN FROM 466WIl142 QUADRANGLE MAP �Q-1 74 2. MUNICIPAL WATER 1 Lj AVAILASLE 3. DESIGN LOADING FOR ALL PRECAST WJ/T5%AA5N0-10-44 Q. PIPE JOINTS SHALL BE MADE WATER 7'16147, l to I, I LI 5. CONSTIZUGTION [DETAILS TO BE IN ACGORdANCE ydlTH Iu w �'� COMM.OF MASS. 677ATF ENVIRONMENTAL CooE TJTGE ]L ��U� Co. TH15 PLAN FOR PROPOSED "RK ONLY AND SHOULD IVOf I _ SE USED FoR PROPE'RrYz LN, STAKING. 3S f 0" Of4y�p� �N 0 M CNe^vLi;rC. 4r� - u = Z Er IU t P,o�J 1F�lt ARNE MATF- �{. �G /1RNE �✓ �� ! Q OJALAlD: ENAGE . PLAN. . ..CIVILoaA �, � u � I !i +.: No. 30792 #26W Ago 9F� O A� E� down cove englne LEGEND: r LOC US :t-OT 7 31 ! AAPP EPI) =� .� /STERN CIVIL ENGINEERS �; CoNrouPs (Exisr) ------ REFERENCE: i, (PROP) --o----�--- LAN D SURVEYORS II CONC.BOUND PREPARED FOR ' PAT ARNE H.OJ^.LP%,PE.,R.L.S. 92co Mainst.Yarmovth,MCl ® C6 I i TEST 90LE board of health SCALE : I it l DATE _ _ JOB NO. �- APPROVED DATE.: �'T-�.i�I ,MA + 8 7 w. .ra - x - f � I LT- I - . I —LTI ED,jM =NEO J. f i� L rl 4— rYxllj( svAJ tZOOM Ai? b1771vnl SCALE: L�/ �! ri APPROV ED BY. DRAWN BY L DATE' �Q /(p �Q9 REVISED S AARo2) My4Lo N r t+N-2oA) ,SM- DRAWING NUMBER 1 r — -- - - -- -_. - - ---._ -- --- -------T _ — I L I I I I I I L A N D ins G . d n ayx P.T. Knox A 'mdP�P 3 N C ,p ! �I� �7� r J�' M tr Ir lr 11 to 30NA /�Jr Y,'M rN r --Lore) SCr-,.APC a x k (' T ax8 :rD + y7 y Q �o o n.-( � a• ax ►o P_T. ODK A•;U�' 50N A,e, 1VI 0)G FOD i Al N , 3 LOW ' 4 4 4 I CON-r"J o v5 y p 20�� Fo o-r N `ro - 1-0O '� �' -.Ik _� o. o o F - s r M PS oy.� ��y-T-ant m- S w� Ff0uSE , FW t! aR _.2x 10 P-i- LEDG—/Z a �. _7N P,u ao c' r % x //a G �a 3'' o} G +� VDU'I1L 7)A---T-1 D,& Z7tG k/N [� �,�a�.l - �C�4 1 PCH E nl �— - 1��N- - -M- --7-- -- r- v0r, PJA-AZ 1 0.5 vL o AL-E tc TP,T 3v CZ io A P HAt-'r 2oCaF , -37A � W�APei- y 5� rn���ES _5 '' TT It) -f _ 2 I T w+41.1.y .�X � �a " GDx (�G_y ev-E� U�,� Ov fa 2 Y.a ' Gt7x , /�+-y r; 3o Pt-voR. -- J5 ��L-7- Hap-+zov-r.A- L `-�� axJa A I � vF- Mob yv�PoRT — •7 R f D G E -i- G D N%. $OF F/ 7- Ix Y i'0z r.mot +x 5 a oo P- V C-N T 1 x.,5 f x & c-ib 0 I"P ffiA aH !o P-4 g- 16 **e9C ? xS 5Kf2 7 - GONTl /V©V t--Ay?-EN-�2-f 80AP- U JkI P--r �K o/,t Ra©+- %o FUDTJNG� i rJ .r ov,v a 1�-T7 oN- rJ �- _ rx. 9 t,4� CIA } /x� DOFF/ -r t x 2 be-3 R-A K� C I ak - ax Y__Tb P 13-r AA , W - _ P-P rCArN'E PAr-T-Er. @,I^i4U X EI- I& i� �l r, 11 X L/ Po 5-; y o eT, eAPS , �to I lit[ } FA � ��K or` AiAPO A"� ax8 Pi7 Rox. ANyLC J a-ax PT. Box A-7-OP X Nx G P-T.. PO.5'T7 7b 1U 5 iv-R �- - a a- .2�, TOP PL47 5 Z�s M � /D" 50'JAS y ' MrN , alv,'b rY- 5"�; 11 " a 3-o�x '? #-E•4J�+� - _ 2 �Low Cr�,4cVE` -� tIeV.GL "�Lov(>._s - axe 5HD'1-= 3�y7%tGSU6, mac.- I G L-V I -t N A L :�, Kro ? /& oC- , a -ax /0 Ar 8ox I I __ I I 1 1-c-dy'10 P T na IB tL �SPPr A70 Ir yoo�,� ' -r � "L— W/ &J G jQd T F-7'6,4 5rP-A P P+,v6 }, $O t.7 �a")C t//a'� 6 PA D;E7 SST r N ,B A y i -r _ E tla��OL .6-AtWAW21ED 1MPSooJ x -ST"p5 A r rAc H-a D -7-0 Po5 T F 4 Ox Ly,r J _o wrnlDow -i- T7Uof2. �jCtI-E DULE Ut-e C�D/.-) sJ v m 13 a R-1 4 . G L�a 5 5 t- 1 T- q 3 x 6, P /5 (.-r DOo 2 3,b �X ZYz" l.ow /2 57,P Z,5 /. 7 G W r S 3 ___ �,�•i X�y " tkvb/C Cow-�T�Ksp G-V SO-Ff- $ /�4cX 9 C t�._. !o o(p Fs 7y ° X Z`/z►` Z)( I~e -? 2Y F9" 30 /1 INISH GRADE OVER D-BOX= 155.5'± 4"SCHEDULE 40 PVC MIN.SLOPE 1 % FINISHED GRADE OVER DIFFUSORS= 155.4' T1 TOP OF FOUNDATION = 164.5'± PROVIDE CONC. RISER WITH INSPECTION PORT WITH SLOPE @ 2/o MIN. 153.4' (T2) ( ) GENERAL NOTES f- COVER OVER INLET&OUTLET FINISH GRADE OVER TANK EL.= REMOVABLE COVER OVER RISER TO ACCESS BOX TO WITHIN 6" 1. UNLESS OTHERWISE NOTED ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISHED GRADE TO WITHIN 6"OF F.G. 157.0' - 158.0' WITHIN 6"OF FINISHED GRADE OF F.G. (ONE PER TRENCH) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FOUNDATION = 162.0'± 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN.ACCESS " f (152.00') 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER(3 TYP.) 96MIN' I " 152.43' (Ti) DESIGN ENGINEER. 9"MIN. 9 MIN. EXIST. SEWER PIPE " 36"MAX. TOP OF SAS/B.O. = 150.43' (T2) 1.2'WIDE COUPLING 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL 36 MAX. ----- 2" DROP MIN. (150.01') SYSTEM UNLESS OTHERWISE NOTED. n _ MIN.SLOPE @1% 6" 3" " 3» g" PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT,THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN EL. _ 3 DROP MAX. _ MIN.SLOPE,% JOINTS(TYP.) 152.00'(TRENCH 1)AND EL. = 150.01'(TRENCH 2)FOR A DISTANCE OF 15'AROUND THE PROP. PVC 10" » 1� 1.33' " PERIMETER 4 PVC IN FROM 7 16 TYP ERIME ER OF THE SAS. UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE SEWER PIPE 14" 153.75' SEPTIC TANK 4"PVC OUT TO 0•90, �P•) 1075"'TYP FEET FROM S.A.S.AND THE TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY + 24"STEP o O r 5. SLOPE ALL SOLID PIPE AT 1.0 /o MINIMUM. Z 155.0 ± 154.001 (153.74 ) (151 .62 ) 12" 152.00'(T1) \-151 .10' (T1)• 149.10' (T2) 2.875'(34.5")--I--5.75' 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. (154.02') 48" OUTLET TEE 153.40' MIN. 153.23'(152.90') 150.00'(Tz) (TYP.) 153.10' 5.0' 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK » ( ) 6"CRUSHED STONE 149.61' (150.70') (TYP.) (148.70') FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS AS-BUILT= 18.5' 22 ZABEL FILTER MODEL#A1801-4x22 OVER MECHANICALLY ( ) 5 MIN. 11.50' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 17.1 TO FND (GAS BAFFLE ON BOTTOM) COMPACTED BASE 31.2 (TYP FOR BOTH TRENCHES) AND DESIGN ENGINEER. 6"CRUSHED STONE 3 OUTLET DISTRIBUTION BOX , 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 158.00' OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE (T1)=TRENCH 1 GROUND WATER ELEV.= < 140.33 "STEPPED" ESTABLISHED ON A NAIL SET IN A TREE AS SHOWN ON PLAN. COMPACTED BASE Q BASE. FIRST TWO FEET OF OUTLET (T2)=TRENCH 2 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSER (PROFILE) BI�ODIFFUSER (END VIEW) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH 10' 6' WIDTH 5' 8"p DEPTH 5' 8" (Dimensions per wggin CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC IC TANK PROFILE Precast Corp., Pocasset,MA) DISTRIBUTION B®/� DETAIL � � ARC 36HC (��6� 6BD) BIODIFFUSERS TO THE DESIGN ENGINEER. *CONTRACTOR TO VERIFY ELEVATION NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA /� REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM S A A APPROPRIATE AUTHORITY. • PERC NO. 12449 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS g LOCATED UNDER PAVEMENT DRIVES OR TRAVELED WAYS IN WHICH CASE • l INSPECTOR: Donna Z. Miorandi,R.S. THEY SHALL WITHSTAND H-20 LOADING. EVALUATOR: Michael Pimentel, E.I.T. ,, CS 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. s DATE: January 8,2009 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. ELEV TOP= 152.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ' -., .. < FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). ELEV WATER= 140.33 � 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PERC RATE= 6 min./inch SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. a DEPTH OF PERC= 42"-60" 16. PROPOSED PROJECT IS LOCATED WITHIN: v ( � m �� �+ TEXTURAL CLASS: 1 ASSESSOR'S MAP 151 PARCEL 78 g MAP 151 ' .. PARCEL 77 OWNER OF RECORD: FRANKLIN DESOUZA ADDRESS: 143 SADDLER LANE 0" 152.00' WEST BARNSTABLE, MA 02668 rEXISTING '1,000 GALLON SEPTIC TANK � � :�. � � ' � � " Litter 151.6T TO BE PUMPED, FILLED WITH CLEAN4 SaA.ND AND ABANDONED / . Fill FEMA FLOOD ZONE C COMMUNITY PANEL# 250001 0015 C Y 17. DEED REFERENCE: BOOK 21768, PAGE 13 42� 148.50 / \ Perc Benchmark "��. � / / \ yr 18. PLAN REFERENCE: PLAN BOOK 420, PAGE 97 Nail Set in Tree , f " _ 60" 147.00' w / / Elev. = 158.00' d f Loamy Sand 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. A rox. M.S.L. + ' �'� C)« x B 10 Yr 5/6 M >" • � t k ` .3 :x . g�4 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE: THIS PLAN IS TO BE USED ONLY L.S.A. ., �� ., ��� ,.�, , . �,,, ;. FOR SEPTIC-SYSTEM UPGRADE_ JG ENGINEERING WILL NOT ASSUME ANY LIABILITY / !;- , FOR USES OF THIS PLAN"OTHER THAN ITS INTENDED PURPOSE. CO N 44 144.50' Medium Sand C 2.5Y 6/6 �ti #143 cif / OD ' MAP 151 �� EXISTING Q°¢ s\ M ,w LOCUS PLAN (some cobbles) PARCEL 47-WOO 3-BEDROOM o �\ s � SCALE: 1"= 1000' LEGEND DWELLING I q 140" 140.33' \ TOF- 164.5'± � I ' No Mottling, Standing or Weeping Observed 50x0 EXISTING SPOT GRADE MAP 151 \ - I w w o O<v - - 50 - - EXISTING CONTOUR PARCEL 78 AS-BUILT C/O v ___ / w\� S /ryp, �4 �+ /� �* p / DESIGN DATA TEST r" I T DATA 50 PROPOSED CONTOUR \ 18,953 S.F.± DECK / PERC NO. 12449 E/T/C EXISTING UNDERGROUND UTILITIES NUMBER OF BEDROOMS(DESIGN) 3 GARAGE O / k LP ~� 1 / 4�_ INSPECTOR: Donna Z.Miorandi, R.S. GAS EXISTING GAS LINE 18.5' /j ! / I DESIGN FLOW 110 GAUDAY/BEDROOM EVALUATOR: Michael Pimentel, E.I.T. W W EXISTING WATER LINE EXISTING LEACHING PIT TO BE TOTAL DESIGN FLOW 330 GAUDAY MAP 151 �S�no / PUMPED, FILLED WITH CLEAN DATE: January8, 2009 � TEST PIT LOCATION gyp. o � SAND AND ABANDONED DESIGN FLOW X 200 % - 660 GAUDAY 7AO3 st8� co % `'- - TEST PIT#: 2 QP EXISTING LEACHING PIT PARCEL79 7TP 1 ELEV TOP= 152.00152. ' �96- AS-BUILT DISTRIBUTION BOXUSE PROPOSED 1,500 GALLON SEPTIC TANK � ELEV WATER= 140.33' O O EXISTING 1,000 GALLON SEPTIC TANK / , PERC RATE_ SLEEVE PROPOSED SEWER PIPE 10 / f / `�� AS-BUILT TOTAL 12 ARC 36HC BIODIFFUSERS INSTALL 12 -ARC 36HC (#3616BD) BIODIFFUSERS AS-BUILT 1,500 GALLON SEPTIC TANK FEET EACH SIDE OF WATER CROSSING / �h Tp 2 o�/ (6 BIODIFFUSERS PER TRENCH) DEPTH OF PERC= EE] 2'0' co �o / TEXTURAL CLASS: 1 AS-BUILT 4"SOLID SCHEDULE 40 PVC PIPE // SYSTEM CAPACITY AS-BUILT 1500 GALLON �\ ►: / - ❑ AS-BUILT DISTRIBUTION BOX SEPTIC TANK �1rO /6 C�� C (62.4')(7.8 SF/LF)(0.70 GAUSQ.FT.)=(TOTAL L.F.OF BIODIFFUSERS)(7.8 340.7 GAL. LEACHING/DDAY 0" 152.00' Q AS-BUILT ARC 36HC(#36166D)BIODIFFUSER AS-BUILT 1.2 FEET WIDE / ��' 4" Litter 151.6T COUPLING `'-_ / AS-BUILT INSPECTION PORT WITH /�,� 2) Q AS-BUILT ARC 36HC(#3616BD)COUPLING ACCESS BOX TO GRADE (TYP OF 2) TOTALS: Fill APPROX. E/T/C LOCATION; GARAGE O 3) 96.87' ACTUAL ELEVATION"AS-BUILT' CONTRACTOR TO VERIFY o B ( ) (1 TOTAL NUMBER OF BIODIFFUSERS: 12 / TOTAL NUMBER OF COUPLINGS: 2 42 148.50 TOTAL LEACHING AREA: 486.7 SQ.FT. REV. DATE BY APP'D. DESCRIPTION TOTAL LEACHING CAPACITY: 340.7 GAL./DAY A Loamy Sand "AS-BUILT" SEPTIC SYSTEM 0y �O� �,� B 10 Yr 5/6 PREPARED FOR: NOTE: 90" 144.50' CAPEWIDE ENTERPRISES 5) EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER LOCATED AT "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO Medium Sand AS-BUILT SWING-TIES ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3,2003(LAST C 2.5Ys/s 143 SADDLER LANE MODIFIED DULY 23, 2008). TRANSMITTAL NUMBER=W000052. (some cobbles) WEST BARNSTABLE, MA DESCRIPTION A B C SCALE: 1 INCH = 20 FT. DATE: MARCH 11 2009 SEPTIC COVER IN (1) - 23.0' 36.5' 140" 140.33' 0 10 20 ao � so FEET SEPTIC COVER OUT(2) - 28.0' 38.5' No Mottling, Standing or Weeping Observed TAOF A{ HN L. � PREPARED BY: NOTE: DISTRIBUTION BOX(3) -- 40.0' 52.0' RESERVED FOR BOARD OF HEALTH USE �� �� CHORCHILL ��� JC ENGINEERING, INC. 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG INSPECTION PORT(4) 38.0' 31.5' -- AS-BUILT U �0C4 m 2854 CRANBERRY HIGHWAY THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. INSPECTION PORT(5) 46.0' 40.0' - EAST WAREHAM, MA 02538 SITE PLAN PLAN - 508.273.0377 SCALE: 1"=20' - Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1553 _ _ �r 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE:OVER DIFFUSORS= 155,4' T1 GENERAL NOTE S TOP OF FOUNDATION= 164.5�' INISH GRADE OVER D-BOX= 155.5± SLOPE @ 2% MIlSV. PROVIDE CONC. RISER WITH INSPECTION PORT WITH 153.4' (T2) COVER OVER INLET&OUTLET FINISH GRADE OVER TANK EL.= REMOVABLE COVER OVER RISER TO ACCESS BOX TO WITHIN 6" 1• UNLESS OTHERWISE NOTED,ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISHED GRADE TO WITHIN 6"OF F.G. , WITHIN 6"OF FINISHED GRADE OF F.G. (ONE PER TRENCH) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FOUNDATION = 162.0'± 157.0 - 158.0 5"DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN.ACCESS 36"MAX. 1 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER(3 TYP.) 9"MIN. 9"MIN 152.43' (T1) DESIGN ENGINEER. EXIST. SEINER PIPE 9" MIN. 36"MAX. TOP OF SAS/B.O. = 150.43' (T2) 1.2'WIDE COUPLING 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL 36 MAX. SYSTEM UNLESS OTHERWISE NOTED. Min%s�oPe��x 6" 3" 2"DROP MIN. 3" 9" PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN EL. _ - 3"DROP MAX. MiN.s�oPe��x JOINTS(TYP.) �I 152.43'(TRENCH 1)AND EL. = 150.43'(TRENCH 2)FOR A DISTANCE OF 15'AROUND THE �- '•33' PROP. PVC 10" 4" PVC IN FROM � 16"TYP PERIMETER OF THE SAS. UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE , SEWER PIPE 14" 153.75' SEPTIC TANK 4"PVC OUT TO 0.90' �P•) 10.75i"TYP FEET FROM S.A.S.AND THE TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. 1 0,± O LEACHING FACILITY 4 24"STEP j 5• SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 55 154.00' 12" 152.00'(T1) .151 .10' (T1); 149.10' (T2) 2.875' (34.5") _�. ' OUTLET TEE 153.40 MIN. 153.23 5.75 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 48" 150.00'(T2) 5.0' (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 22"ZABEL FILTER 6"CRUSHED STONE (NP) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION.SYSTEM IS 5 MIN. MODEL#A1801-4x22 OVER MECHANICALLY 11.50, NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 17.1'TO FND (GAS BAFFLE ON BOTTOM) COMPACTED BASE 31.2'(TYP FOR BOTH TRENCHES) AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX 6"CRUSHED STONE 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 158.00' OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE _ GROUNDWATER ELEV.= < 140.33 „ ,� ESTABLISHED ON A NAIL SET IN A TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET (T1)=TRENCH 1 STEPPED COMPACTED BASE PIPES TO BE LAID LEVEL. (T2)=TRENCH 2 BIODIFFUSER PROFILE BIODIFFUSER END VIEW) 9• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION PROPOSED 1500 GALLON CONCRETE SEPTIC TANK ( ( THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT LENGTH + 10' 6' WIDTH 5' 811 DEPTH 5' 8" (Dimensions per Wiggin CROSS SECTION VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE Precast Corp., Pocasset,MA) DISTRIBUTION C.�X DETAIL 12 ARC 36HC (#3616BD) BiODIFFUSE:R5 TO THE DESIGN ENGINEER. *CONTRACTOR TO VERIFY ELEVATION NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC.STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING r TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM a ` 1- APPROPRIATE AUTHORITY. �r PERC NO. 12449 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS INSPECTOR: Donna Z. Miorandi, R.S. LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING. � _ � �� � • �� EVALUATOR: Michael Pimentel, E.I.T. DATE: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. January 8,2009 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE o ELEV TOP= 152.00' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, ;wR ELEV WATER= < 140.33' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). r 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN PERC RATE= 6 min./inch I SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. N 4 DEPTH OF PERC= 42"-60" 16. PROPOSED PROJECT IS LOCATED WITHIN: m )� TEXTURAL CLASS: 1 ASSESSOR'S MAP 151 PARCEL 78 Z MAP 151 g 6 OWNER OF RECORD: FRANKLIN DESOUZA !D n• � /'�� / PARCEL 77 s+pr +'•�, z '.: . � ' o` � ADDRESS: 143 SADDLER LANE 0. 152.00 WEST BARNSTABLE, MA 02668 EXISTING 1,000 GALLON SEPTIC TANK � � ` Litter 151.67 �O TO BE PUMPED, FILLED WITH CLEAN ;' � + `' 4" SAND AND ABANDONED / / \ v 4 Fill FEMA FLOOD ZONE C COMMUNITY PANEL# 250001 0015 C 42' 148.50' 17. DEED REFERENCE: BOOK 21768, PAGE 13 ' \ Benchmark .. Perky / Nail Set in tree k * 18. PLAN REFERENCE: PLAN BOOK 420, PAGE 97 1 60" 147.00 S ` Elev. = 158.00' Loamy Sand 19. ALL DISTURBED AREAS SHALL BE RESTORED l O ORIGINAL CONDITION. v: x c A rox. M.S.L. B 10 Yr 5/6 L.S.A. a ' „�' ` �� 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY kY co N w '.. , - =FOR SEPTIC SYSTEM UPGRADE:'JC ENGINEERING WILL NOT ASSUME-ANY LIABILITY_ _ - •- t- * � FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. " 1 , I , , Medium Sand �. C 2.5Y 6/6 MAP 151 ��ti #143 0¢� / wz EXISTING Q �0 ' LOCUS PLAN- (some cobbles) i PARCEL 47-WOO 3-BEDROOM 0 �� SCALE: 1"=1000' 140" 140.33' \ DWELLING ' ! I o ^ O� No Mottling, Standing or Weeping Observed LEGEND MAP 151 \ TOF= 164.5'± p o � 9 9 p 9 PARCEL 78 v -W 'w� W V w �y <v�0 50xO EXISTING SPOT GRADE DESIGN DATA TEST PIT DATA _ \ 18,953 S.F.± DECK ��� coo ^' / / ys � - 50 - - EXISTING CONTOUR NUMBER OF BEDROOMS(DESIGN) 3 PERC NO. 12449 ! 50 PROPOSED CONTOUR GARAGE f / ���� INSPECTOR: Donna Z.Miorandi, R.S. 17.1' O � LP � - DESIGN FLOW 110 GAUDAY/BEDROOM EVALUATOR: Michael Pimentel, E.I.T. E/T/C EXISTING UNDERGROUND UTILITIES { r -� EXISTING LEACHING PIT TO BE TOTAL DESIGN FLOW 330 GAUDAY MAP 151 PUMPED, FILLED WITH CLEAN DATE: January 8,2009 GAS EXISTING GAS LINE 7st��O�tB �S / ti SAND AND ABANDONED DESIGN FLOW X 200 % = 660 GAL/DAY TEST PIT#: 2 W✓ W EXISTING WATER LINE PARCEL 79 �7, 7y / USE PROPOSED 1,500 GALLON SEPTIC TANK TP 1� PROPOSED ELEV TOP= 152.00' TEST PIT LOCATION 152. ' DISTRIBUTION BOX ELEV WATER= < 140.33' �cb ��jkL QP EXISTING LEACHING PIT ° ) PERC RATE_ SLEEVE PROPOSED SEWER PIPE 10 co 77 ° ,ham PROP. TOTAL 12 ARC 36HC BIODIFFUSERS INSTALL 12 -ARC 36HC (#3616BD) BIODIFFUSERS _ ( O EXISTING 1,000 GALLON SEPTIC TANK FEET EACH SIDE OF WATER CROSSING ^h TP 2 / (6 BIODIFFUSERS PER TRENCH) DEPTH OF PERC- L� 152.0' �co / TEXTURAL CLASS: 1 SYSTEM CAPACITY O O O PROPOSED 1,500 GALLON SEPTIC TANK PROPOSED 1500 �\ I GALLON SEPTIC TANK N O/ / (TOTAL L.F.OF BIODIFFUSERS)(7.8 SF/LF)(0.70 GPD/SQ.FT.)= GPD PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE (62.4')(7.8 SF/LF)(0.70 GAUSQ.FT.)= 340.7 GAL. LEACHING/DAY 0" 152.00' PROPOSED 1.2 FEET / / Co �' Litter 13 PROPOSED DISTRIBUTION BOX WIDE COUPLING �_ i PROPOSED INSPECTION PORT WITH ��' 2) 4" 151.67 ACCESS BOX TO GRADE (TYP OF 2) �' TOTALS: Fill I� PROPOSED ARC 36HC(#3616BD)BIODIFFUSER APPROX. E/T/C LOCATION; GARAGE O CONTRACTOR TO VERIFY o GC-2 3) (1 TOTAL NUMBER OF BIODIFFUSERS: 12 0 PROPOSED ARC 36HC(#3616BD)COUPLING TOTAL NUMBER OF COUPLINGS: 2 42" 148.50' / TOTAL LEACHING AREA: 486.7 SQ.FT. �OJ 4) TOTAL LEACHING CAPACITY: 340.7 GAL./DAY Rom• DATE BY APP'D. DESCRIPTION / v j- GC-1 Loamy sand PROPOSED SEPTIC SYSTEM UPGRADE Q Q� B 10 Yr 5/6 Q S� PREPARED FOR: � ho ° CO (6 ° NOTE: 90. 144.50' CAPEWIDE ENTERPRISES EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE 5) DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER LOCATED AT "MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO Medium Sand SWING-TIES ADVANCED DRAINAGE SYSTEMS, INC.ON OCTOBER 3,2003(LAST C 2.5Y 616 143 SADDLER LANE ¢• MODIFIED JULY 23,2008). TRANSMITTAL NUMBER=W000052. (some cobbles) DESCRIPTION GC-1 GC-2 WEST BARNSTABLE, MA SCALE: 1 INCH = 20 FT. DATE: JANUARY 9,2009 SEPTIC COVER IN(1) 39.6' 20.5' 140" 140.33' 0 10 20 ao eo FEET SEPTIC COVER OUT(2) 46.3' 25.6' No Mottling,Standing or Weeping Observed ASH oFM mmod NOTE: BIODIFFUSER CORNER 3 47.4' 29.2' 'gym O RESERVED FOR BOARD OF HEALTH USE ��""L. aw PREPARED BY: �"JR:"��� JC ENGINEERING, INC. 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG VIL BIODIFFUSER CORNER(4) 56.1' 39.8' CI4'BC7 2854 CRANBERRY HIGHWAY THE TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. BIODIFFUSER CORNER(5) 45.4' 42.2' EAST WAREHAM, MA 02538 SITE PLAN- BIODIFFUSER CORNER(6) 34.1' 32.5' tµ 508.273.0377 SCALE: 1"=20' Drawn By: MCP Designed By:MCP Checked By:JLC JOB No.1553 -. I I